No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
My view of the sanctity of life: A rebuttal of John Keown’s critique
Abstract
In a previous paper in this journal I responded to Professor John Keown’s criticisms of the British Medical Association guidance on withholding and withdrawing life-prolonging treatment, arguing that the sanctity of life principle he endorses is indefensible as a juridical and moral guide. Professor Keown replied recently, also in this journal, alleging that I wrongly caricatured the sanctity of life position he supports, which continues to illuminate the proper decision-making path in relation to the withdrawal or withholding of life-sustaining medical treatment. In this present paper it is submitted that Keown’s riposte is misconceived and disguises the true nature of the sanctity of life stance, which both rests upon unconvincing premisses and tends towards unacceptable repercussions, thus leading to its inevitable and rightful rejection.
Is it lawful for a doctor to give a patient life-shortening pain relief? Can treatment be lawfully provided to a child under 16 on the basis of her consent alone? Is it lawful to remove food and water provided by tube to a patient in a vegetative state? Is a woman's refusal of a caesarean section recommended for the benefit of the fetus legally decisive? These questions were central to the four focal cases revisited in this book. This book revisits nine landmark cases. For each, a new leading judgment is attributed to an imagined judge, Athena, who operates within the constraints of the legal system of England and Wales. Her judgments accord with an innovative legal theory, referred to as 'modified law as integrity', and are linked as a line of precedent. The result is a re-spinning of extant judicial threads into a web of legal principles with a greater claim to coherence and defensibility than those in the original cases. The book will be of great interest to scholars and students of medical law, criminal law, bioethics, legal theory and moral philosophy.
IntroductionDefinitionsIs there an ethical obligation to prolong life?Is there a moral distinction between killing and letting die?Is there a moral distinction between intending and foreseeing a consequence?What legal duties are owed at the end of life?Is there a legal obligation to prolong life?Is it lawful to withhold and withdraw life-saving treatment from children?Can a child be deliberately killed?What rights do parents have to determine treatment?The court's roleThe relationship between law and ethicsReferences
The aim of this article is to present an account of an important element of medical ethics and law which is widely cited but is often confused. This element is most frequently referred to as ‘the principle of the sanctity of life’, and it is often assumed that this language has a religious provenance. However, the phrase is neither rooted in the traditions it purports to represent nor is it used consistently in contemporary discourse. Understood as the name of an established ‘principle’ the ‘sanctity of life’ is virtually an invention of the late twentieth century. The language came to prominence as the label of a position that was being rejected: it is the name of a caricature. Hence there is no locus classicus for a definition of the terms and different authors freely apply the phrase to divergent and contradictory positions. Appeal to this ‘principle’ thus serves only to perpetuate confusion. This language is best jettisoned in favour of clearer and more traditional ethical concepts.
Terms such as sanctity and inviolability have failed to provide a legally coherent or ethically sound principle upon which to determine the scope of the intrinsic value of life against extrinsic, quality-of-life considerations in a medical context. In their recent work, Margaret Brazier and Suzanne Ost introduce a new term, reverence for life, which they suggest may be more appropriate when attempting to navigate the murky waters of the meaning of life and the value that should be attached to it. They suggest that reverence should be utilised as an alternative that better reflects the nuances and the realities of the dilemma. This paper explores the existing difficulties before considering how the principle of reverence might provide a principled compromise over when the presumption in favour of preserving life should be rebutted.
Law and Ethics in Children's Nursing is an important and practical guide on the legal and ethical spects of child healthcare that enables nurses to understand the legal and ethical principles that underpin everyday nursing practice. It explores the concept of childhood and children's rights, the extent to which their rights are upheld in a variety of settings, and the relationship between law and ethics and how they interact in resolving problems and dilemmas that commonly arise in practice. With case studies, learning outcomes and scenarios throughout, Law and Ethics in Children's Nursing places the care and treatment of children in a legal and ethical framework, and explores the way in which legal and ethical aspects of children's nursing differ from those of adults. It explores general principles such as autonomy and consent, confidentiality, accountability and negligence. It then goes on to look at specialist areas such as abortion, sterilisation, research, mental health, organ donation, child protection and death.
Those involved in end-of-life decision making must take into account both legal and ethical issues. This book starts with a critical reflection of ethical principles including ideas such as moral status, the value of life, acts and omissions, harm, autonomy, dignity and paternalism. It then explores the practical difficulties of regulating end-of-life decisions, focusing on patients, healthcare professionals, the wider community and issues surrounding 'slippery slope' arguments. By evaluating the available empirical evidence, the author identifies preferred ways to regulate decisions and minimise abuses at the end of life, and outlines an ethical theory which can provide practical guidance for those engaged in end-of-life decisions.
In their book Debating Euthanasia, Emily Jackson and John Keown present respectively arguments in favour of and against the legalization of (some instances of) euthanasia and assisted suicide. Jackson advances a case based on a principled commitment to a secular, liberal legal system, arguing that obligations rooted in compassion require the careful development of laws to permit assisted dying. Keown defends the status quo, arguing that the law ought to sustain a prohibition against assisted dying, both out of a principled commitment to the inviolability of life doctrine, and because satisfactory regulation will be impossible to draft. I question the strength of each author's essay. Jackson, I argue, does not take sufficiently seriously the plausibility of secular moral objections to assisted dying. Keown, meanwhile, overstates the inviolability principle's place in English law. Focusing particularly on Keown's essay, I go on to consider the approach taken to 'debating euthanasia', and suggest that it betrays more about the direction of the public debate, and the fragility of 'the case against', than he would perhaps wish. © The Author 2012. Published by Oxford University Press. All rights reserved.
Autonomous self-determination by competent adults is a cornerstone of medical law. We argue that the application of Kantian autonomy as the paramount model for self-determination at end of life is questionable as it fails to capture subtler nuances of decision-making in this context. We propose an alternative model which we term ‘holistic determination for oneself’ and posit this as a potential contender to the traditional Kantian construct. The paradigm of holistic determination is conceptualised on the basis of sub-determinations which coalesce to form the final determination. This paradigm offers a unique perspective that is multi-axial (based on the levels of decision-making) and multi-dimensional (based on an on-going temporal inter-relational and integrative synthesis of decisions at all levels). Holistic determination for oneself offers a paradigm that is tempered, universal and optimal for self-determination at end of life.
We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the USA explores the claim that justification in ethics, whether of matters of theory or practice, involves achieving coherence between our moral and non-moral beliefs. Amongst the practical issues addressed in the volume are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy.
This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to “positive” health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed.
“NOT only would it be a bold and brave judge … who would seek to interfere with the discretion of doctors acting under the Abortion Act 1967, but I think he would really be a foolish judge who would try to do any such thing, unless, possibly, where there is clear bad faith and an obvious attempt to perpetrate a criminal offence.” So said Sir George Baker P. in Paton v. B.P.A.S. and his view has been repeated at apposite judicial moments in subsequent cases. Recently, however, a legal attempt was indeed made to question the discretion of doctors in Jepson v. The Chief Constable of West Mercia Police Constabulary. Reverend Joanna Jepson asked the West Mercia Police to investigate doctors who had authorised an abortion for bilateral cleft lip and palate at 28 weeks under the disability ground of the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990). Abortion is legal under that section if two doctors have formed an opinion in good faith that “there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”.
‘therapy’ is a legal concept of considerable import, traditionally juxtaposed with, but separate from, research and also, to some degree, marking the boundaries of legitimate medical intervention. the recent case of simms highlighted these issues, in addition to which novel clinical interventions were the subject of specific recommendations in the bristol royal infirmary inquiry report. this article subjects the notion of therapy to analytical scrutiny and considers the extent of proper clinician discretion to innovate and, albeit much more superficially, how medicine should itself evolve. it advocates a new, more (patient) protective model which should generate confidence in the ethical character of contemporary innovatory practices.
Choices and rights’ (1998) 13 Disability and Society 665 at 682
- T Shakespeare
above n 1, as to the ‘oddness’ of my assertions in this regard, my position is not only clear but surely it is also self-evident that if the negative aspects of living which have driven the individual’s decision were to be removed, that individual would no longer entertain such a prospect
- Despite Thus
- Keown
Restoring the sanctity of life and replacing the caricature: a reply to David Price) LS 109. This was a response to D Price ‘Fairly Bland: an alternative view of a supposed new "Death Ethic" and the BMA guidelines
- J Keown
above n 4 states, at para 11.1, that a patient might perhaps seek a short prolongation of life in order to sort out one’s affairs or achieve a particular goal
- Bma The
Adult: Refusal of Medical Treatment)
- B Seere
An intractable dispute: when parents and professionals disagree’ (commentary onRe Wyatt (A Child) (Medical Treatment: Parent’s Consent)
- M See
- Brazier